Behavioral Disturbances in Dementia and Beyond: Time for a New Conceptual Frame?

Ambrogio, Federico; Martella, Lucia; Odetti, Patrizio; Monacelli, Fiammetta

doi:10.3390/ijms20153647

Cited by 16 publications

(5 citation statements)

References 83 publications

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“…Therefore, the external validity of this finding is limited. In accordance with previous reports [26, 33], there was also consensus in our study regarding the need to have protocols for the use of atypical antipsychotics for BPSD in order to help physicians in clinical practice and in benefit of patients and their families, a finding that could indicate an insufficient knowledge or application of guidelines in practice [34-36].…”

Section: Discussionsupporting

confidence: 88%

Use of Antipsychotics in Patients with Behavioral and Psychological Symptoms of Dementia: Results of a Spanish Delphi Consensus

Manzano-Palomo

Agüera-Ortíz

García-Caballero

et al. 2020

Dement Geriatr Cogn Disord

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Background: Behavioral and psychological symptoms of dementia (BPSD) are difficult to manage and associated with poor outcome. Objectives: The aim of this study was to reach consensus on the use of antipsychotics in patients with BPSD in Spain. Methods: A qualitative, multicenter, two-round Delphi study was carried out, with the participation of specialists involved in the care of dementia patients throughout Spain. They completed a 76-item questionnaire related to the identification of BPSD, treatment with antipsychotics, follow-up of patients, barriers for the use of atypical antipsychotics, and effects of antipsychotics on quality of life. Results: A total of 162 specialists in neurology, psychiatry, and geriatrics (61% men) with a mean (SD) age of 45.9 (10) years participated in the study. Almost all participants (96.9%) strongly agreed that atypical antipsychotics are safer and better tolerated than typical antipsychotics. There was agreement on the importance to review the indication and dose of the antipsychotic drug at least every 3 months. There was consistent high rate of agreement on the beneficial impact of atypical antipsychotics on the quality of life of patients with dementia and their caregivers. A consensus was also reached on the need of detecting BPSD in patients with dementia as it decreases the quality of life of both patients and caregivers, and the need to routinely screen for dementia in elderly patients with no previous psychiatric history in the presence of suggestive symptoms of BPSD. Finally, the participants in the study agreed that administrative barriers for the prescription of atypical antipsychotics in Spain hinder the access to this drug group and favor the prescription of typical antipsychotics. Conclusions: The participants in the study agreed that atypical antipsychotics should be preferred to typical antipsychotics in the management of BPSD. Wide consensus was reached about the importance of early identification of BPSD in persons with cognitive impairment, the use and management of atypical antipsychotic drugs and their favorable impact on patients and caregiver’s quality of life.

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Section: Discussionsupporting

confidence: 88%

Use of Antipsychotics in Patients with Behavioral and Psychological Symptoms of Dementia: Results of a Spanish Delphi Consensus

Manzano-Palomo

Agüera-Ortíz

García-Caballero

et al. 2020

Dement Geriatr Cogn Disord

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“…Thus, the complete pharmacological profile and possible side effects (beyond cognitive) of donepezil remain poorly understood (Jelic and Darreh-Shori, 2010), necessitating further in-depth translational studies using both longterm and acute treatments. This problem is important since affective and other behavioral deficits are particularly common An acetylcholinesterase inhibitor, donepezil, increases anxiety and cortisol levels in adult zebrafish in AD patients (Ambrogio et al, 2019;Khachaturian and Radebaugh, 2019), yet there are no established and approved pharmacotherapies to treat these deficits (Khachaturian and Radebaugh, 2019).…”

Section: Introductionmentioning

confidence: 99%

An acetylcholinesterase inhibitor, donepezil, increases anxiety and cortisol levels in adult zebrafish

et al. 2020

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Background: A potent acetylcholinesterase inhibitor, donepezil is a cognitive enhancer clinically used to treat neurodegenerative diseases. However, its complete pharmacological profile beyond cognition remains unclear. The zebrafish ( Danio rerio) is rapidly becoming a powerful novel model organism in neuroscience and central nervous system drug screening. Aim: Here, we characterize the effects of 24-h donepezil administration on anxiety-like behavioral and endocrine responses in adult zebrafish. Methods: We evaluated zebrafish anxiety-like behaviors in the novel tank, the light-dark and the shoaling tests, paralleled by assessing brain acetylcholinesterase activity and whole-body cortisol levels. Results: Overall, donepezil dose-dependently decreased zebrafish locomotor activity in the novel tank test and reduced time in light in the light-dark test, likely representing hypolocomotion and anxiety-like behaviors. Donepezil predictably decreased brain acetylcholinesterase activity, also increasing whole-body cortisol levels, thus further linking acetylcholinesterase inhibition to anxiety-like behavioral and endocrine responses. Conclusion: Collectively, these findings suggest negative modulation of zebrafish affective behavior by donepezil, support the key role of cholinergic mechanisms in behavioral regulation in zebrafish, and reinforce the growing utility of zebrafish models for studying complex behavioral processess and their neuroendocrine and neurochemical regulation.

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“…Some studies have suggested that the dementia subtypes do not present differences in terms of behavioral and psychological symptoms. The intensity of neuropsychiatric symptoms in dementia subtypes may fluctuate over time, and several factors, including various underlying neurobiological changes, comorbidities, pathologies in cerebral vascularization, and age play a role in such fluctuations [22]. In addition to cognitive loss, Alzheimer's disease also presents symptoms such as behavioral changes, psychosis, mood swings, apathy, agitation, and abnormal motor behaviors [23].…”

Section: Discussionmentioning

confidence: 99%

Distribution of neuropsychiatric profiles and comorbid diseases in dementia subtypes

Bülbül,

Karşıdağ,

Çınar

et al. 2024

The European Research Journal

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Objectives: Alzheimer’s disease (AH) is the most prevalent cause of dementia, followed closely by vascular dementia. Mixed vascular-Alzheimer’s dementia (MVAD) is more evident in individuals aged 80 and above. Frontotemporal dementia (FTD) is the second most common cause of early-onset dementia after AH. Vascular risk factors play important role in the pathogenesis of dementia syndromes. Behavioral and psychological symptoms represent a significant portion of the non-cognitive manifestations in dementia patients. This study aimed to evaluate the distribution of chronic diseases, behavioral disorders, psychiatric findings, and medication use in patients followed with different dementia diagnoses. Methods: Prevalance of chronic diseases, behavioral disorders, psychiatric findings as well as the usage of antidepressant and antipsychotic medications among patients followed up in dementia outpatient clinics with the diagnosis of AD, mild cognitive impairment (MCI), vascular dementia (VaD), FTD, and MVAD were investigated. Neuropsychiatric inventory (NPI) was applied to the patients. Results: Four hundred and fifty-five patients were accepted in the study. The patients were distributed as follows: AD (n=303, female/male: 187/115, age = 78±8 years), MCI (n=53, female/male: 31/22, age = 69±10 years), VaD (n=31, female/male: 18/13, age = 68±9 years), FTD (n=32, female/male: 17/15, age = 68±9 years), and MVAD (n=36, female/male: 16/20, age = 76±10 years). Both AD and MVAD groups were significantly older than the other groups (F = 23.2, P<0.0001). The ratio of comorbid chronic diseases was 80% in the AD group, 72% in the MCI group, 91% in the VaD group, 59% in the FTD group, and 93% in the MVAD group. In the whole group, antipsychotic drug use was 27.5% and antidepressant drug use was 28.9%. The mean NPI score was 32.9±28 in antipsychotic users and 16±19 in non-users (P<0.0001). The mean NPI of antidepressant users was 17.6±19 and 21.9±25 (P=0.055) in non-users. Conclusion: There is a comorbid chronic disease burden in all dementia subtypes, although at varying intensities, and as the chronic disease burden increases, behavioral disorders and psychotic findings increase, and accordingly, the use of antipsychotics also increases.

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Behavioral Disturbances in Dementia and Beyond: Time for a New Conceptual Frame?

Cited by 16 publications

References 83 publications

Use of Antipsychotics in Patients with Behavioral and Psychological Symptoms of Dementia: Results of a Spanish Delphi Consensus

Use of Antipsychotics in Patients with Behavioral and Psychological Symptoms of Dementia: Results of a Spanish Delphi Consensus

An acetylcholinesterase inhibitor, donepezil, increases anxiety and cortisol levels in adult zebrafish

Distribution of neuropsychiatric profiles and comorbid diseases in dementia subtypes

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